Now Viewing: Community Development

To Heal a Community, Build Capacity

Jul 20, 2016, 11:00 AM, Posted by Laura Porter, Martha Davis

Lessons from Washington State show a culture shift can lead to healthier lives.

Neighbors gather around a home at night.

About 15 years ago, non-profit and public service providers in Cowlitz County, Wash. were trying to figure out why—despite great planning and programming—there were still problems in the neighborhood that made the most 911 calls. The prevailing wisdom was that the neighborhood was dangerous because it was dark outside people’s homes, and it stayed dark because people liked it that way. It helped conceal criminal activity. But the coordinator for the service collaborative knew she needed to engage with residents and learn what they thought. So to start to figure out what was happening, she went house by house to talk to people.

As those discussions with community residents grew, it became clear that residents saw things differently.

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Helping Mid-Sized Cities Think Big About Health

Jan 13, 2016, 2:00 PM, Posted by Donald Hinkle-Brown

A new initiative will empower mid-sized cities across the U.S. to develop strategies for increasing private and public investments to improve neighborhoods facing the biggest barriers to better health.

People running along park.

Cincinnati, Ohio. Flint, Michigan. New Orleans, Louisiana. Springfield, Massachusetts. The names of many of America’s mid-sized cities are woven into the fabric of our national consciousness.

Others are less well known: Broken Arrow, Arizona. Pasco, Washington. Taylorsville, Utah.

Famed or not, cities boasting populations of 50,000 to 400,000 are where most Americans live. Mid-sized cities can be great places for a healthy, rewarding life. Many have a strong sense of community and history, with less hustle and bustle and traffic and lower cost of living than big cities.

But even in places where quality of life is generally good, not everyone benefits equally. All together, more people live in poverty in America’s mid-sized cities than in large metro areas. Even the most storied of these cities have neighborhoods facing some of the nation’s deepest challenges. And many such cities have suffered economic depression for decades.

My organization, Reinvestment Fund, works closely with cities to use data to better understand the needs of their most at-risk neighborhoods — and then invest in new initiatives that can revitalize housing, health, transportation, education, and other assets that help communities become stronger and healthier. Now, with the Robert Wood Johnson Foundation, we want to help dozens of mid-sized cities think big about ways they can improve health in their most underserved neighborhoods.

To do that, we’ve launched Invest Health, which is giving 50 mid-sized cities $60,000 each to start to map out the kinds of changes they want to make.

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Community Development For and By the Community

Jul 13, 2015, 12:37 PM, Posted by Jasmine Hall Ratliff

Many families face rising rents they can’t afford. One local developer revamped an aging historic hotel into affordable housing to transform: "community development being done TO us.. to development done BY us."

Boyle Hotel before and after renovations. Before: The Boyle Hotel in disrepair. After: The Boyle Hotel-Cummings Block Apartments bring 51 new apartments to the neighborhood, all priced for people making between 30 to 50 percent of the area’s median income.

Ten years ago, Los Angeles’ Boyle Hotel was more than down on its luck. The grand old Victorian dame, built in 1889 by an Austrian immigrant and his Mexican wife, was uninhabitable. Over the years neglect had turned the stunning building with intricate period details into a ramshackle apartment house with shared bathrooms and communal kitchens. The wiring was faulty and the pipes leaked. Mold bloomed up walls. Rats scurried along the hallways. Absentee landlords racked up housing code violations, ignoring the residents’ repeated requests for basic protections of their safety and health.

Most of the tenants were older, single men: many of them mariachi musicians scraping by from gig to gig. They’d spend their weekends across the street in the plaza, as generations had going back to the 1930s, exchanging news and waiting for word of a quinceñeara or wedding where they might play. The musicians were a cultural anchor for the neighborhood, so much so that the residence was nicknamed the Mariachi Hotel.

The hotel sits at the peak of a steep hill, and if you look just beyond it you can see the full glory of downtown LA glinting in the sun. Maria Cabildo, Co-Founder and President Emeritus of the East LA Community Corporation (ELACC) and current Chief of Staff to the LA County Supervisor, saw the writing on the wall: The Boyle Hotel was bound to be snapped up by developers, and replaced by luxury rooms with a view if nobody attempted to save it. With plans for the LA Metro to extend its new light rail into the heart of the plaza, she knew that new development wouldn’t be far behind. What would the influx of business mean for the residents – mariachi musicians and families alike – who’d long called the neighborhood home?

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Public Health Institutes: Lessons Learned

Jun 7, 2012, 6:02 PM, Posted by NewPublicHealth

The National Network of Public Health Institutes (NNPHI) Annual Conference in New Orleans, La., concluded late last month. We caught up with some of the attendees and NNPHI leaders to get their thoughts on conference highlights.

Ellen Rautenberg, President and CEO, Public Health Solutions and NNPHI Board Chair:

 

“Dr. Jo Ivey Boufford, a keynote speaker discussed activities Institutes are currently doing at the intersection of public health and primary care and provided her thoughts as to how Institutes might expand on these. She felt that Institutes were perfectly poised to keep the attention of policy makers on population health as they address cost and quality of the health care system.”

Bob St. Peter, President and CEO, Kansas Health Institute:

 

“It was a great conference. NNPHI walked the talk of multi-sectorial partnership. What other public health conference could you go to where the three keynote speakers are from the New York Academy of Medicine, the Federal Reserve Bank and AcademyHealth? Thinking beyond our traditional partners in public health is becoming increasingly important as our health system hopefully moves to one that is more accountable and more effective.”

NewPublicHealth also spoke with Christopher Kinabrew, MPH, MSW, director of Government and External Affairs for NNPHI to capture conference themes and highlights of the hallway conversations.

NewPublicHealth: What were some of the themes you heard in conversations by attendees?

Christopher Kinabrew: In terms of some of the themes that came through, one important one was that now more than ever, neutral conveners are needed at the state and local level for so many different initiatives. This is critical now in areas such as building bridges between health care and public health. That came through in the keynote from Jo Ivey Boufford and the discussion on the Institute of Medicine report.

There’s also this concept of “backbone organizations.” For many of these initiatives, it’s not a one-time thing. For community health assessments, for example—there’s the assessment itself, but then after that there’s a whole community improvement process. There needs to be some accountability and structure for that to happen. More and more we’re seeing the need for a backbone organization to continue that work. In some cases it’s the public health institute, and in other cases it’s an organization that spun off. I heard in some of the hallway conversations, some examples in the area of health information exchange where the public health institute incubated the exchange, but then in the end it became its own separate entity.

NPH: What other themes did you hear?

Christopher Kinabrew: Health reform was also a big theme for us at the meeting. There were so many comments that regardless of the outcome, “the genie’s out of the bottle.” These changes are happening. The decision will have an impact, but in many of these initiatives the conversation has already changed, so prevention is going to move forward regardless.

Another theme was about funding being consistently under attack. There was a lot of conversation about public health institutes being a hub or a nexus for alternative funding mechanisms. We’ve known for a while that the institutes are good at leveraging federal funding, private foundation funding, and contracts with state and local funding health departments—they’re able to do some things that perhaps other organizations can’t do because of that funding mix. David Erickson from the Federal Reserve also got people thinking about even more alternative financing and funding mechanisms for public health, in terms of working with community development financial institutions.

NPH: From what you learned at the meeting and during David Erickson’s presentation, what are some of the ways public health institutes, health departments and community development institutions can work together?

Christopher Kinabrew: It’s really about putting the social determinants of health into action. He made the comment that community development folks might need to change their language and terminology to say “we’re in the health business.” In terms of the evaluation and measurement of these investments, public health partners could bring the type of robust evaluation that goes on in the health sector to the table for community development. There was a lot of interest in increasing capacity across our membership in health impact assessments. That’s an areas where we could all work together to put some health measures in community development investments and boost the evaluation capacity. That’s an area where our members do tend to be really strong.

It’s not new to see our members working across sectors, but to me in this conference there was a marked difference in really working upstream across sectors to advance a health in all policies approach. This is something that’s talked about in the National Prevention Strategy. We held a breakout on health in all policies around the intersection of agriculture, food systems and public health. That session was packed.

NPH: You moderated the Town Hall on community health assessment. What came out of this discussion?

>>Read up on community health assessment as part of community benefit initiatives.

Christopher Kinabrew: We featured two national organizations—The Hilltop Institute and United Way Worldwide. We know from our members that first and foremost they want to share what they do and are looking for best practices. Martha Somerville, director of Hilltop’s Hospital Community Benefit program, laid the groundwork on community benefit responsibilities for nonprofit hospitals and for how public health institutes could facilitate meaningful collaboration between hospitals, health departments and community-based organizations. In her presentation and throughout all of the presentations, there was a theme that it’s not just about the needs assessment—it’s also about the community health improvement planning and the structure for implementing those strategies.

From Sandra Serna Smith at the United Way, we heard about their massive coverage and the strength of their network, in terms of covering 95 percent of the population. What was also interesting was learning about the United Way’s three pillars—education, income and health. They made the point that if any one of these isn’t strong, the rest fall. That really resonates well with our members.

We had Kevin Barnett from the Public Health Institute moderating the session. That was a great opportunity because he’s a content expert in community benefit and community health assessment. Two of our members also shared their experiences from the ground—the Texas Health Institute, which brought one of the local public health departments they worked with, and they told the story of how they worked together. Laurie Call from the Illinois Public Health Institute compared and contrasted her experience with two different counties. All of these examples included robust partnerships with public health institutes, health departments and hospitals, and United Ways were often involved sometimes as a funder but also as a partner in implementation.

An interesting question from the audience was, what sector didn’t you include in the process that you would have looking back? Both local panelists mentioned transportation. Looking ahead, that’s maybe a key sector we want to involve next year.

This commentary originally appeared on the RWJF New Public Health blog.

David Law: "Determined to Bring Healthy Choices Into Our Neighborhoods"

Mar 14, 2012, 2:45 PM, Posted by NewPublicHealth

In Detroit, Michigan, the Joy-Southfield Community Development Corporation has developed a targeted approach to promoting health equity, based on the four factors measured by the County Health Rankings: health behaviors, clinical care, social and economic factors and physical environment. Despite its location in one of the most racially segregated cities in the country, with poor public transportation, high poverty and unemployment, and vast food deserts, the Joy-Southfield neighborhood has become a hub of partnerships and activities aimed at long-term health improvement. Several community groups and funders have collaborated to empower youth through mentoring and community garden projects; renovate vacant properties to attract new businesses; improve community safety; provide job training and foreclosure prevention services and more.

NewPublicHealth spoke with David Law, PhD, Executive Director at Joy-Southfield, about the program.

NewPublicHealth: Tell us about the Joy-Southfield Community Development Corporation. How did your priorities evolve, and how did the County Health Rankings help shape them?

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Designing Healthy Communities: NewPublicHealth Q&A with Richard Jackson

Jan 27, 2012, 5:59 PM, Posted by NewPublicHealth

"Designing Healthy Communities,” a four-part series funded in part by the Robert Wood Johnson Foundation, debuts this month and next on many Public Broadcasting stations. The program looks at the impact the built environment has on key public health problems such as obesity, diabetes, heart disease, asthma, cancer and depression. In the series, host Richard Jackson, MD, MPH, professor and chair of environmental health science at the UCLA School of Public Health, connects bad community design with burgeoning health costs, then analyzes and illustrates what citizens are doing about this crisis by looking upstream for innovative solutions.

NewPublicHealth recently caught up with Dr. Jackson, who will also be a featured speaker at the New Partners for Smart Growth Conference in San Diego next week, leading a session on “Health as a Messaging Tool.” Dr. Jackson received the New Partners for Smart Growth Lifetime Achievement Award in 2008.

NewPublicHealth: What prompted the "Designing Healthy Communities" series?

Dr. Jackson: My background is that I’ve worked in environmental health in one form or another for over 30 years. I started out as a pediatrician and have become more and more focused on the whole mix of environment and health and the outcomes and the impacts on our population, acute impacts such as asthma, car injuries, all the way through to chronic diseases, cancer and birth defects, and I’ve investigated all of them. And then beyond chronic diseases, long-term health impacts such as endocrine disrupters in the environment and health effects of global climate change.

I spent nine years as the Director for the National Center for Environmental Health and I was State Health Officer for California for a year and a half, and I’ve become increasingly convinced that I’m sitting at the end of the disease pipeline waiting for somebody to come in the door with obesity-related diabetes, with injuries related to a bad urban design or for that matter a lack of adequate crosswalks. Asthma and even heart disease are related to very poor air quality. That it is not feasible for the future of our country. When I was a young doctor, seven percent of all the money in the United States that was going to medical care. It’s now more than 17 percent, and the U.S. is still ranked about number 50 in life expectancies worldwide.

So, we’re not doing something right, and I would assert that what we’re not doing right is we’re failing to really operate in the realm of prevention. We’re not going far enough upstream in thinking about what things are affecting our health. What I would assert is a big driver that’s affecting our health but it’s also affecting our happiness, our prosperity, and our future is how we have built America. We have built it for the needs of cars and other short-term needs, maximizing sale of commodity foods of various kinds and we have not built it with an eye towards people and an eye towards future generations.

I co-wrote a book ten years ago called “Urban Sprawl and Public Health,” and then became much more focused on these issues of built environment and co-wrote a textbook, where we very deeply document the impact of the built environment on everything that you would imagine, but also further upstream to obesity and lack of fitness, and even further upstream to unhappiness, to depression, and we began to think that just as this damaged environment can have multiple negative health outcomes, creating health environments should have positive health outcomes. And that’s why the television series is called “Designing Healthy Communities."

Ten years ago there really was very little recognition of this issue, but that’s changing. There were almost 300 sessions that either had the words “built environment” or “land use” at the last American Public Health Association National Meeting in early November in Washington, DC.

NPH: What’s driving that increasing interest?

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Community Development and Public Health: A Q&A with David Erickson

Jun 13, 2011, 7:13 PM, Posted by NewPublicHealth

David Erickson

How can the billions of dollars that are spent each year on community development make the places where we live, learn, work and play healthier?

That question is among many debated today by leaders in urban planning, housing, government, business, philanthropy, public health, and health care, who are gathering at the New York Federal Reserve to share ideas about making communities healthier--together.

The meeting is supported by the Robert Wood Johnson Foundation, which is partnering with the Federal Reserve Banks of San Francisco and New York, the New York Academy of Medicine, and the Primary Care Development Corporation, to bring traditional and non-traditional partners together to find common ground on addressing the social and environmental factors that influence health. This is the fourth meeting like this that David Erickson, PhD, who manages the Center for Community Development Investments for the Federal Reserve Bank of San Francisco, has convened in the past year. He talked to NewPublicHealth.org about today’s Healthy Communities Conference and why community developers and public health advocates are natural partners.

NPH: You’ve said that health is too important to be left to the health sector alone. But how do you engage groups that don’t speak the same language to even sit at the same table and work on an issue that is relatively foreign to many of them? How do you help those in the transportation, housing, education and health sectors bridge their differences and roll up their sleeves and work together?

Erickson: It is much easier than you might think though there are challenges. We often confuse each other just in the language that we use. We say CDC and we mean community development corporation but for people in public health that acronym means something entirely different. But in terms of our work, there is a strong and immediate bond. We often start our meetings with a local health expert showing heat maps with red colors representing neighborhoods with the worst health outcomes. If you pick asthma, for example, you see which neighborhoods light up in red. We then have community development experts put up a similar map to look at things like overcrowded housing or high unemployment rates and you see maps that are practically identical. Instantly, everyone in the room realizes that we are working together to address problems for the same communities.

Those of us in community development work in the large financial world and banks are our biggest partners but we are not always understood by them. People who do community development have an immediate affinity and understanding for those in population health and vice versa. Where we do stumble is how we make it concrete. Those of us in community development know how to put grocery stores in food deserts or build, locate and finance small businesses. But we struggle with how to link more effectively to federally qualified health centers or connect housing with improving public health. We need to do better at taking approaches to community development that are geared toward attacking the root causes of bad health. That is a real challenge. What we are trying to do is find the best ideas and practices so we can create a playbook to show us how.

NPH: This is the fourth of several meetings you’ve had like this. What are your goals coming out of these meetings? How do you keep the conversation going and ultimately push it beyond just talk into action?

Erickson: We have multiple goals. Some are more achievable than others. One goal has been to just do some consciousness raising, which we have been successful with. People are more knowledgeable about these issues and more sophisticated about how to approach needs. The other goal is to just get people to meet each other. We have been successful in creating local partnerships. For example, a group of researchers from the University of California, Berkeley attended one of our meetings in Los Angeles and met a group of housing experts from Mercy Housing, a nonprofit Catholic affordable housing developer. The researchers are now teamed up with this group to do a health analysis for a 50-acre public housing site in San Francisco that wants to incorporate health into development. A community developer just doesn’t have time to pour over all the health literature. Now they have this built in advisory committee from Berkeley, who are leaders in the field of population and public health, who are helping them. Plus, they will have the data and analysis to figure out what the health effects are of remaking a community. We hope that during the process that not only will Berkeley researchers be able to feed back strategic information so developers can make adjustments in the best interest of their tenants but also realize what this means from a health perspective to radically improve a neighborhood. This is a partnership that emerged from a conversation begun at a reception we held during the meeting. We have similar stories coming out of Boston, where the Boston Community Foundation is working with the Boston Federal Reserve on a local housing project and Los Angeles, where researchers at UCLA are beginning discussions with Federal Reserve staff in Los Angeles.

NPH: So what is the take-away message from all of these encounters or opportunities?

Erickson: I have been doing community development for 20 years and frankly it gets kind of depressing. While there are plenty of wins out there - places that seemed hopeless are now thriving thanks to community development - if you look at the overall numbers, we are not winning the war against poverty and unhealthy communities. As a community developer, I find that when we start talking to health professionals, I find new allies. These are people who have new ideas, resources and energy to put into this effort. So it is very energizing.

NPH: The measures for success for the public health and financial sectors seem to be at opposite ends of the spectrum. Banks and community developers tend to see themselves as short-term lenders and want to see short-term wins. Investments in public health often take years if not decades to show promise. How do you convince your financial partners that the ROI for investing in improved health is worth it?

Erickson: Some look to childhood reading levels as an indicator of prison population eight years out. That is something we could be looking at – intermediate measures – such as childhood reading rates or high school graduation levels or unemployment levels – to assess whether health is improving. Community developers are increasingly on the hook to try to explain the benefits that come from community development interventions. Increasingly we are going to look to health as a partner in measuring the success or failure of those interventions. That will be an important part of the community development toolbox going forward.

NPH: What can community development and finance experts teach health experts and vice-versa? Have these meetings yielded some key lessons that others can learn from that are trying to do the same thing?

Erickson: One thing that community developers are very good at is being plugged into a local community and understanding their needs and connecting them to much bigger systems and resources at a much greater scale then they can source locally. They are on the side of the community but also can go to Wall Street and tap sources of capital as well as the federal government. They can bring in this whole symphony of players to work on a project. And that would be helpful to health. The community developer can play that coordinating role and bring the right players to the table that assemble and harmonize the right subsidy and market rates for capital. I think the two working together will be a powerful combination. Health can teach us a lot about measurement and being more methodical to make sure we stay with what is working and discontinue what doesn’t seem to be helping. It also helps community developers broaden their focus to improve the health of local people.

NPH: Do you believe then that we are moving to a new way of dealing with health at the community level?

Erickson: We know from studies that only about 10 percent of premature deaths are related to access to health care and environmental and social factors are much more significant. If we are going to keep the country healthier and make some improvements in the overall health of the people here, we really have to improve those areas so people don’t get sick in the first place. People understand that you can live a healthier life but I think what people don’t often understand is the gradient for improved health. It’s not just that poor people are sick and wealthy people are not. It’s that at every income bracket as your income rate rises, people tend to be a little healthier. If you have a sense of control over your life, you tend to live better and live longer. We are increasingly understanding that people in local communities feel like they have no control over their lives. We think we can intervene in those places and give them a sense of control and translate that into significant health improvements.

NPH: Do you feel like you’re having impact? Can you share a story of how you’ve affected change or gotten a non-health sector to think differently about improving the places we live, learn, work, and play?

Erickson: We still have a way to go but we are changing the conversation and that is an important step. I think it’s definitely changing how we in community development think about how we do our work. One small example is that the lead umbrella organization for community development finance – Opportunity Finance Network – has a conference every year that is attended by anyone who does community development finance work in the United States. Now they have a health track as part of the meeting. They never had that before. We do think we will see concrete changes soon. Housing and Urban Development is pushing for sustainable communities and focusing on the effects of place on health. We see this happening with transportation projects too. Agency heads in charge of health and city leaders are starting to work together and that has been unprecedented. This is still relatively new but it is pretty remarkable that at the highest levels, there is interest in bringing different components together to build healthier communities.

We recently held an equitable transit-oriented development conference here at the San Francisco Federal Reserve Bank and there was a discussion about building affordable housing units near a train stations. A train station in a community increases land value because it provides access to transportation. The developers not only looked at what it would do for the economy but they also factored in how it would affect health, and saw from studies that it would foster physical activity and reduce obesity rates. It was unusual to think about building a train station using the lens of public health but it shows that health is becoming part of the equation for community development.

This commentary originally appeared on the RWJF New Public Health blog.